Étude des mouvements anormaux dans une population non sélectionnée de patients ambulatoires souffrant de schizophrénie

Abstract : Résumé anglais : Schizophrenia is a chronic and debilitating disorder with a lifetime prevalence near 1%. The clinical manifestations are diverse. No single symptom is definitive for the diagnosis. There is currently no imaging or lab test available for the diagnosis of schizophrenia. The clinical presentation is characterized by positive, negative and disorganized symptoms. These symptoms must be present for a significant period and cause major social dysfunction. Schizophrenia results in the impairment of neuropsychological functions, in particular, of attention, memory and executive functions. The stability of these symptoms over time allows schizophrenia to be distinguished from schizoaffective and mood disorders with psychotic features. Comorbidities and mortality rates are elevated in schizophrenia and patients die 12–15 years before the average population. Treatment is required to maintain/improve social functioning and prevent symptom relapse, which are causing a significant public health and economic burden. Successful treatment of the first schizophrenic episode is crucial to minimize social and vocational deterioration. Antipsychotics are the mainstay of schizophrenia treatment. Typical or first-generation antipsychotics (FGAs) and atypical or second-generation antipsychotics (SGAs) are effective for positive symptoms. However, FGAs cause more extrapyramidal motor side effects (EPS) and tardive dyskinesia (TD) than SGAs, whereas SGAs generally cause more weight gain. Drug induced parkinsonism (DIP) usually develops in patients with schizophrenia treated with antipsychotic drugs. DIP usually appears days to weeks after starting antipsychotics but sometimes the onset may occur several months or years after treatment initiation. DIP symptoms usually recover within a few months after medication withdrawal. However, in some cases, parkinsonian signs persist or even worsen, suggesting the development of Parkinson’s disease (PD). A number of questions arise from these observations: how can DIP be distinguished from PD? Are patients with schizophrenia at a premotor stage of PD that is unmasked by antipsychotic drugs? Are these drugs toxic to dopaminergic neurons in the basal ganglia? If so, are some classes more toxic than others? Should we propose levodopa therapy for schizophrenic patients with parkinsonism and striatal dopaminergic denervation on dopamine transporter imaging? What assumptions can be made from the above? First, some clinical symptoms are helpful for the distinction between DIP from PD; symmetric parkinsonism and orolingual dyskinesia are suggestive of DIP. Second, even after drug withdrawal, some patients with DIP continue to worsen suggesting degeneration of nigrostriatal dopamine neurons. This hypothesis has been supported by studies in patients chronically exposed to dopamine receptor blocking agents (DRBA). DAT imaging was either normal or abnormal in these patients challenging the notion that DIP might be entirely due to post-synaptic D2-receptor blockade by DRBA. Third, there is speculation of possible neurotoxic effects of neuroleptics on a susceptible dopamine neurons eventually causing neuronal death The two aims of our study are, firstly, to summarize the published literature on abnormal movement disorders, especially extrapyramidal motor side effects (EPS) in schizophrenia, and, secondly, to determine the prevalence of EPS as well as the risk factors and treatments associated with EPS in a cohort of patients with schizophrenia followed at the French expert centres for schizophrenia.
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Submitted on : Thursday, December 15, 2016 - 12:55:06 PM
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Antoine Daubigney. Étude des mouvements anormaux dans une population non sélectionnée de patients ambulatoires souffrant de schizophrénie. Médecine humaine et pathologie. 2016. ⟨dumas-01417170⟩

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